Thread by @hyderabaddoctor

Young woman with unexpected cause of repeated bouts of vomiting
1. 1999: It was another busy day, when I had seen 60 outpatients, worked up & written case notes for 8 ward admissions and had finished seeing 14 consultations (from other depts). It was 2 AM and I needed some sleep.

2. Residency at CMC Vellore in 90s was tough, which denied even 4 hours of sleep on many nights. Got a call from Gastro ward regarding a 25-yr old woman who had repeated episodes of vomiting for one week. Detailed evaluation by gastro dept could not identify the cause of vomiting

3. Neurology opinion was sought to rule out neuro-related causes of vomiting (such as cyclical vomiting syndrome, brain-stem lesions, migraine, etc).
I took a detailed history. She had no symptoms other than vomiting. On examination, she was dehydrated and looked weak.

4. Neuro exam was normal. Instead of ordering brain scan, I asked ward nurse to do "urine pregnancy test". The nurse was shocked-"Dr, don't you know she is a nun?". I said, I know and I have taken her consent for the test. Since there is no relative with her, her consent is final

5. With great reluctance, nurse agreed to do the test. The "positive" test increased her shock & she almost collapsed.
I gathered courage and along with nurse, informed the patient about positive report of urine pregnancy test.
Seniors were informed & appropriate referral given

6. I remembered our gynecology prof words- "for amenorrhea (missing periods) or vomiting in a woman of child-bearing age, never forget to look for pregnancy".
As a doctor, our job is to make correct diagnosis and reduce the suffering of patients, without being judgmental.

7. This was an unusual case seen by me as a first year resident trainee in #Neurology about 25 years back. It posed ethical and moral dilemma as well, which as doctors, we often need to deal with.
#MedTwitter #neurotwitter #obstetrics #pregnancy #HyperemesisGravidarum